Forensic_randomised Flashcards
Name some differences between forensic and clinical
- Forensic more assessment heavy
- Higher importance of truth and veracity in forensic
- More complex presentations
- More involuntary clients
What are the major problems with Gen 1 Unstructured Clinical Judgement Risk Assessment?
There are 5
- Very inaccurate (false pos error rate - 86%
- No set rules or method
- Inconsistency within and between clinicians
- Underpinned by clin experience, which varies
- Effected by cognitive biases and heuristics
Elements of Risk Assessment
What are the two factors being examined when assessing ‘harms’ in risk assessment?
- Ability to produce risk (i.e., actually capable of re-offending? If in custody, less likely)
- Lethality of risk (i.e., in DV strangling more risky than pushing)
What information is needed for a pre-sentencing report?
There are 12 to name
- Presentation
- Family Background
- Education
- Employment
- Relationships (partners/friends)
- Culture
- Health (physical/mental/AOD)
- Offence history
- Index offence
- Psychometric testing
- Client plans
- Clinician reccomendations
Elements of risk assessment
Name the two categories of risk factors
One of these has two sub-categories, name these also
- Static
- Dynamic (stable + actute)
What are the three main skills for forensic interviews.
Give example of each
- Respectful interactions (polite, calm, collected)
- Attending skills (i.e., culturally appropriate eye contact, vocal qualities)
- Active listening skills (i.e., open questions, paraphasing)
What are the 7 general limitations of risk assessment
Across all generations - not specific
- Sample representativeness (who is norm based on?)
- Criterion definition of risk (is it risk of re-arrest or re-conviction?)
- Criterion measurement of risk (research follow-up limited, predictive validity may be inflated + level of risk may be impacted by unreported evidence)
- No certainty - impossible to be 100% certain
- Only as valuable as info available and clinician scope of competence
- Limited shelf-life (risk can change)
- Many risk assessment tools are not evidence-based (only 25% generally favourable)
What are the ten major elements of assessment?
(Ten tasks psych does from file review to defending in court)
- File review
- rapport building
- consent
- choose actuarial and SPJ tests
- Assessment: clinical interview + testing
- Collatoral interviews
- Test marking/interpretation
- Report writing
- Debrief clients
- Defending in court
APS 8.1
What is the main ethical concern with appropriateness of standardised test?
Many assessments are not valid or have not been validated with certain populations. Example:
* First Nations people
* Women
Gen 4 Risk Assessment
What is included in the case management/progress record sections of the LS/CMI?
Case management: list of criminogenic needs, non-criminogenic needs, and special responsivity considerations. PLUS strategies to address these.
Progress record: log of activities designed to measure change resulting from CM strategies
What were the five core ethical concerns in forensic psych listed in the lectures?
- Informed consent
- Appropriateness/limitations of standardised tests
- Multiple relationships
- Objectivity, unbiased, fair testimony
- Difficulty of impartial testimony when also working as treating psych (balancing wellbeing with accuracy)
What should psych’s consider if there is history of concussions, ODs, or physical victimisation?
Brain injury
Why is informed consent even more important with forensic clients?
Rights and liberties may be at stake + clients may not be accurately aware of these risks
Gen 3
What are the three major areas of the HCR-20?
- Historical
- Clinical (present)
- Risk-management (future)
Gen 3 Risk Assessment
Name some of the areas covered in the ‘History’ section of the HCR-20
- Past violence
- Age of violence
- Relationships
- Employment
- Substance use
- Mental illness
- Psychopathy
- Maladjustment
- Personality disorder
- Supervision failure
What are dynamic risk facors? What are the two types of dynamic risk factors?
Give example of two types
Risk factors that fluctuate over time
Types:
1. Stable: slow change (i.e., substance use disorder)
2. Acute: fast change (i.e., intoxication)
Elements of Risk Assessment
What does ‘factors’ refer to?
Variables increasing risk of re-offending
What does reintegration mean?
Reintegration occurs when an offender can become an active, productive law-abiding part of a community. Note: should we even call this re-integration, if not integrated to begin with?
What does the continuum of risk refer to?
Risk is a continuum, not static.
People are dynamically located at different points of this continuum overtime, depending on circumstances
Gen 4 Risk Assessment
What are the three major areas covered in the SARPROF?
List some examples covered by each
- Internal (i.e., intelligence, secure attachment, empathy, coping, self-control)
- Motivation (i.e., work, leisure activities, finances, treatment motivation, authority attitudes, goals)
- External (i.e., social network, relationships, professional care, current living, external control)
Gen 3 Risk Assessment
Name some of the areas covered in the ‘Clinical’ (present) section of the HCR-20
- Insight
- Attitudes
- Active mental illness
- Impulsivity
- Responsive to treatment
Elements of Risk Assessment
What two factors are examined when assessing ‘likelihood’ in risk assessment?
- Base rates (population rates of that particular offence. Low base rate = less data, lower prediction accuracy).
- Quality of estimation (i.e., psychometrics of assessment tool used)
What stage of the Stages of Change model are forensic clients usually in?
What can be done in this phase? And is treatment recommended in this phase?
Pre-contemplation phase
Motivational interviewing can be helpful.
Intensive treatment not reccomended in this stage due to risk of drop-out
RNR Treatment Model
What is considered in the ‘Risk’ (who to treat) section of the RNR model?
Intensity should match risk of re-offending
High risk = high intensity
Low risk = low intensity (or even no treatment)
APS 4.1
What information do clients need to be given during informed consent?
There are 6 to name
- Purpose of assessment
- Anticipated use of findings (what will happen with this info)
- Who will have access to info
- The referral question
- Confidentiality and it’s limits
- Voluntary/involuntary nature of assessment
What is an example of a Gen 2 Static Risk assessment tool
Static-99R
Describe the time-lag/delay for offestting criminogenic effects with rehab treatments?
What does this mean for treatment plannning?
When starting treatment, there is a delay before rehab effects start to offset criminogenic effects (dynamic risk factors)
For this reason, it is not reccommended for someone to start treatment on a short sentence (because treatment drop-out is a risk factor for re-offending)
RNR Treatment Model
What is considered in the ‘Needs’ (what to treat) section of the RNR model
List examples (there are 8)
Treatment is focused on crimonogenic needs (dynamic factors)
1. Anti-social associates
2. Anti-social personality
3. Anti-social cognitions
4. Family/marital issues
5. Education/work problems
6. Lack of leisure/recreations
7. Hx of antisocial behaviour
8. Substance misuse
What is Gen 2 Risk Assessment?
Actuarial (static)
Static risk score calculated based on population data on the relationship between static risk factors and recidivism (i.e., age at first offence)
What is an advantage of Gen 2 Risk assessment?
Outperforms Gen 1 in accuracy
Gen 4 Risk Assessment
List some of the types of risk covered in the LS/CMI
- Specific risks (personal problems with criminogenic potential i.e., hx or perpetration, racist behaviour)
- Institutional factors (hx or incarceration/barriers to release)
- Other client issues (mental/physical health, finances, accomodation, victimization)
- Special responsivity (responsive/idiosyncratic risks - informed by research + correctional opinion)
RNR Treatment Model
What is considered in the ‘Responsivity’ (how to treat) section of the RNR model?
There are two categories of considerations
How to maximise participation and treatment efficacy
- General factors (common to everyone i.e., therapeutic alliance)
- Specific factors (individually tailored considerations i.e., culture, literacy/language, AOD, individual goals)
Treatment
Describe the Good Lives Model
4 answers listed
Strengths based model
Builds on individuals capacities and strenghts (and acknowledges that we do not all have the same opportunities)
Views offending as a product of desire for something inherently normal/human
Does not think restricting activity is the only way to avoid offending (i.e., re drug use, goal can be sobriety or safe use/harm-reduction)
Gen 3 Risk Assessment
Name some of the areas covered in the ‘Risk Management’ (future) section of the HCR-20
- Feasibility
- Destabilisers
- Personal Support
- Compliance
5. Stress
What is Gen 3 Risk Assessment?
SPJ - static + dynamic
Considers dynamic risk factors that are:
1. conceptually justified (change must be possible)
2. Empirically justified (related to recidivism risk)
Name two reasons for assessing risk
- To manage/mitigate risk (to individual and community)
- Plan treatments and recommendations (and to match rehab efforts with crimonegenic need)
Elements of Risk Assessment
Risk assessment is comprised of assessing factors, harms, and likelihood.
What does ‘harms’ refer to?
The nature/type of harm (i.e., sexual vs assualt vs theft)
What are some disadvantages of Gen 3 Risk assessment?
There are 3
- Coding schemas are inflexible
- Only cover a designated set of dynamic factors
- Focus on group-based risk factors (ignores individual and idiosyncratic risk factors - i.e., covid lockdown may decrease risk for someone who steals but increase risk for DV perpetrator)
APS 4.1
How do forensic psych’s conduct an assessment who does not have capacity to consent?
Get consent from legal representative. BUT even with this consent, still need to get assent from client.
Gen 4 Risk Assessment
What is the override feature in the LS/CMI?
Clinician can override risk/need score using structured clinical judgement
What is the RNR treatment model?
What are the three areas to consider?
- Risk - who to treat?
- Needs - what to treat?
- Responsivity - how to treat?
Standard treatments like CBT and DBT are still conducted but within an RNR frame
What are the three major elements assessed during risk assessment?
- Factors
- Harms
- Likelihood
How should Gen 4 SARPROF assessment be used?
In combination with 3rd Gen HCR-20
How can forensic psych’s control for unreliable self-report/malingering?
- Gather info from multiple sources
- Use validated, objective assessment tools
What is a Gen 4 Risk Assessment tool that only examines protective factors?
SARPROF
What are advantages of Gen 3 Risk assessment?
There are 3
- Outperforms gen 1 + 2 in most cases
- Captures dynamic risks
- Can be used to guide intervention
What is Gen 4 Risk assessment?
SPJ + static + dynamic + case mgmt + responsivity
Guided by empirically driven static + dynamic risk
PLUS clinician adjusts level of risk based on individual factors (responsivity) i.e., cultural factors, intellectual capacity, health etc.
Measures: level of risk, needs, AND strengths
Structured mechanism for monitoring change + facilitating rehab included
What is an example of a Gen 4 tool?
Note: one that includes static + dynamic not just protective
LS/CMI
Level of Service/Case Management Inventory (Andrews & Bonta)
Extention of Gen 3 LSI + case management options
What are disadvantages of Gen 2 Risk assessment?
There are 5
- Item selection is a-theoretical (does not explain why sexually offending against men increases risk)
- Static factors (mostly) stay same or increase over time (same score at 16 and 45)
- Doesn’t focus on intervention
- Does not capture dynamic risk, or changes to person, circumstance, or environment
- Risk communicated at group-level
What are the five cognitive biases/heuristics that impact Gen 1 Risk Assessments?
- Availability heuristic (relying on info that easily comes to mind)
- Bias blind spot (false belief that we are less biased than others)
- Base rate fallacy (over-estimating risk if you think murder is more common than it is)
- Illusory correlation
- Confirmation bias
What is the Gen-3 Risk Assess Tool you will use
HCR-20
